Provider Demographics
NPI:1801369038
Name:GARCIA ROMAN, TAMARA L (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:GARCIA ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0067
Mailing Address - Country:US
Mailing Address - Phone:787-951-4826
Mailing Address - Fax:
Practice Address - Street 1:18 AV SEVERIANO CUEVAS KM 141.1
Practice Address - Street 2:BO CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-0000
Practice Address - Fax:787-819-0805
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR022196208D00000X
PR14977-I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice